Randy Larimer lives in Bozeman. Despite living in what counts as a larger city in Montana, he has struggled to find help when his adult child has experienced a mental health crisis.
"With Bipolar II, basically what our family member has is a manic episode where they can run for weeks without sleep," Larimer explains.
He says these episodes have led to suicide attempts.
Mental health professionals say the state’s crisis system needs three components in order to prevent that kind of outcome: someone to call, someone to physically respond, and somewhere for people to go for treatment.
Mental health professionals say the state’s crisis system needs three components in order to address suicide attempts: someone to call, someone to physically respond, and somewhere for people to go for treatment.
Montana’s three crisis call centers address that first step. According to state data, 988 system workers are able to de-escalate two-thirds of callers.
But sometimes someone to talk to on the phone isn’t enough, and advocates say the two remaining parts of Montana’s crisis system aren’t working.
Larimer says when his son needs in-person care, it’s usually police that respond and his family winds up in the emergency room where the search for a crisis stabilization service begins. Those facilities in western Montana have struggled to remain open due to staffing shortages and funding difficulties.
"A lot of times you spend a significant amount of time literally begging for a bed at a unit that can offer the help that your loved one needs," Larimer says.
"A lot of times you spend a significant amount of time literally begging for a bed at a unit that can offer the help that your loved one needs." Randy Larimer
And things are even more difficult in largely rural eastern Montana where these services don’t exist in many communities.
Brenda Kneeland is CEO of the Eastern Montana Community Mental Health Center, which doesn’t offer crisis services. She says her outpatient clients are usually hundreds of miles away from the nearest mental health facility, where wait lists for a bed can be up to three weeks long.
"That’s a reality in eastern Montana that we face every single day," Kneeland says.
Rural communities across the country face these sorts of challenges, says Ben Miller, a psychologist and national mental health policy advocate.
"I’m afraid that what’s going to happen is a lot of individuals are going to continue to show up in the emergency department from their call to 988 or 911 unless we have a place that we can send them," he said.
He says without trained mental health care workers nearby, patients are more likely to face worse consequences, like being jailed. Miller also points to research that estimates at least one in four fatal law enforcement shootings involve someone with a serious mental illness.
"I’m afraid that what’s going to happen is a lot of individuals are going to continue to show up in the emergency department from their call to 988 or 911 unless we have a place that we can send them."
The ideal, Miller says, would be for states like Montana to offer mobile crisis units to de-escalate someone or transport them to a regional crisis bed where they can receive treatment.
Without adequate trained mental health staff in Montana, law enforcement officers with limited training and resources can be the ones responding to people in crisis.
Without adequate trained mental health staff in Montana, law enforcement officers with limited training and resources can be the ones responding to people in crisis.
Fallon County Undersheriff Nic Eisele says several times he’s helped people and families find crisis treatment services, but sometimes the nearest place for people to go for care has been in North Dakota or Wyoming.
"One in particular I had this last year fell on Christmas Eve," Eisele said. "That call in particular turned into an 18-hour day trying to get this individual to the place that he needed."
Eisele says finding a bed is only the first part of the challenge. Many times, both his office and local medical services aren’t able to transport someone to these facilities, leaving them or their families to find their own way.
State health officials are trying to bolster both response and treatment services.
Montana has six mobile crisis teams, and there are three more teams due to come online soon. However, most are based in counties with urban centers that can afford them.
Melissa Higgins is a behavioral health and developmental disabilities bureau chief with the Montana state health department. She’s working to get Medicaid funding in place to expand this work, especially in rural areas.
"Certainly, it’s dependent upon each community and their resources, but that would be the ideal result," she said.
Higgins says the state will offer grants by next year to help providers bolster the number of crisis treatment facilities. But providers like Eastern Montana Community Mental Health Center say they would need a large infusion of cash to build and maintain infrastructure and staff.
"Just like every other social service provider in the state is struggling to hire and retain employees, ever-rising costs, now is really a difficult time to look at taking on an endeavor like that," said the center's CEO, Brenda Kneeland.
An ongoing state assessment of Montana’s mental health care crisis system could offer potential solutions ahead of next year’s legislative session. But what the Legislature will fund is still unclear.
In the meantime, Bozeman resident Randy Larimer says it can be hard to remain positive about the current state of services, knowing that his adult child will eventually have to navigate this system without his help.
"We had a lot of professionals tell us to just let them go," he said. "I can’t do that and I won’t do that."
He says he won’t stop advocating until he sees the services his family needs made available across the state.
If you or someone you know may be considering suicide, dial 988.
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